- Commonwealth Care Alliance (Boston, MA)
- …timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role ... Utilization Management , the Nurse Utilization Management (UM) Reviewer is...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Commonwealth Care Alliance (Boston, MA)
- … Management is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible ... reports to the Director of Utilization Management - Oversees clinical decision review for...reviews). - Hire, train and mentor UM staff, including nurse reviewers and support personnel. - Act as liaison… more
- Alameda Health System (San Leandro, CA)
- Nurse , Care Management + San Leandro, CA + San...in Case Management in an acute setting or utilization review at a medical group or health plan. ... Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …to perform discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This position requires ... Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Day 5x8-Hour… more
- Aveanna Healthcare (Birmingham, AL)
- …the plan of care and patient needs. Participates in quality improvement, utilization review , and infection control activities as requested. Attends appropriate ... $7500 Sign-On Bonus Position Overview: The Hospice Registered Nurse is responsible for pain management , symptom control in the delivery of care to hospice… more
- ERP International (San Diego, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Health Educator** supporting **Naval Medical Center San Diego, CA ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Katmai (Fort Carson, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. ... those required of any military or government civil service nurse of similar experience and in similar duty assignments....and employ safe work habits. + Utilize available information management systems in daily practice for patient care and… more
- Luke Staffing (Glendale, CO)
- **REGISTERED NURSE ** **SITE OF SERVICE:** Department of Veterans Affairs, Eastern Colorado Healthcare System (ECHCS), 4100 E. Mississippi Ave, Glendale, CO 80246 ... AM - 5:30 PM (excluding federal holidays) **POSITION OVERVIEW:** The Registered Nurse (RN) will provide on-site professional nursing services to beneficiaries of the… more
- ERP International (Camp Lejeune, NC)
- …providers for 90% of all referrals. + Provides timely, descriptive feedback regarding utilization review issues. + Reviews and enters first right of refusal ... full-time **Licensed Practical** **/Vocational Nurses (LPN/LVN)** in support of Referral Management Center at theNaval Medical Center Camp Lejeune, NC. Apply online… more
- Skaggs Community Hospital Association (Branson, MO)
- …patient care team toward goal achievement in accordance with Standards of Nurse Anesthesia Practice, National Standards of Care as identified by respective ... to other team members. Excellent communication skills, leadership ability, time management , and problem solving skills required. * Job Requirements ◦ Education… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …of Texas or compact license + 3+ years Nursing experience + 1+ years Utilization Management and Appeals experience + Excellent verbal, written and computer ... **UM RN Appeals Coordinator.** This role collaborates with clinical review staff, medical directors/physician reviewers, network physicians, and network facilities… more
- Bryan Health (Lincoln, NE)
- …to appropriate provider. *Maintains awareness of financial reimbursement methodology, utilization management , payer/reimbursement practices and regulations and ... (2) years recent clinical experience required. Prior care coordination and/or utilization management experience preferred. Basic Life Support (CPR) certification… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization Management experience + Experience working in the health plan industry… more
- Stanford Health Care (Palo Alto, CA)
- …in clinical research, research, ICU, other intensive care setting, pediatrics, case management or nurse navigation preferredHuman subjects' protection and Good ... with minimal directions. + Understand and respond to multiple personalities and work/ management styles. + Resource management / utilization knowledge in… more
- Stony Brook University (Stony Brook, NY)
- … Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were… more
- Commonwealth Care Alliance (Springfield, MA)
- …Intensive Care (CIC) programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel ... with significant medical, behavioral, and social complexities that require intensive care management and care delivery. Within the CIC Program, the Community Health… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... quarter.** **What you will do:** + Performs medical necessity review that includes inpatient review , concurrent ...Three (3) years of clinical experience ( **Required)** + Utilization Management experience (Preferred) + Experience working… more
- Alameda Health System (San Leandro, CA)
- …preferred. Minimum Experience: Two years related in acute care facility and/or utilization review training. Minimum Experience: Varied clinical experience or ... Management issues; other issues including concerns involving under/over utilization , avoidable days and quality issues. Coordinate daily with interdisciplinary… more
- Commonwealth Care Alliance (Springfield, MA)
- …efforts + Participates in regular Interprofessional Care Team meetings and Team Case Review . + Participates in Risk Management meetings as needed. + Conducts ... Intensive Care (CIC) programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel… more
Related Job Searches:
Management,
Nurse,
Nurse Reviewer,
Reviewer,
Utilization,
Utilization Management,
Utilization Management Nurse,
Utilization Management Reviewer